Q&A: Nurse Leaders on Affecting Outcomes Through Leadership

HLM: That's an interesting way of making the healthcare reform principles part of their practice.

Davis: We have trained a number of our staff in quality improvement tools. We also have a department in our quality institute that is focused on performance improvement. We are a part of TCAB (Transforming Care at the Bedside).

So we've used a more of a project-based approach where we're taking principles of just-in-time training on how to utilize data and tools; and how to look at the work on a particular unit and decide what where there's value, what might we improve; what's creating difficulties for patients and for staff and how can we improve those outcomes.

We call our model our "unit-based care model" where we have used the tools to really define the standard work for the nurse, the support staff on the unit, the physicians that predominately work on those patient care units. [We] have brought that together in a number of ways.

One of the more notable is our integrated team rounds on our general medicine and general surgery units where we evaluate the patient scheme as a team, and it's enabled us to reduce complications, reduce length of stay, and improve overall satisfaction for our patients and our staff that work on those units.

So in many ways it's a lot of the similar principles that Judy mentioned, but different approaches to how can we create lower costs, take out waste and improve our clinical outcomes.

HLM: Is it easy or hard to get individual bedside nurses involved? To get all of them involved and all of them engaged?

Watland: Getting all of them engaged, I think is hard because there are some people who willingly and proactively want to be engaged and want to be involved and then you have those who honestly probably don't want to be involved as much.

But I guess to go back to what I was talking about before with some kind of peer coaching. If you're actively involved, taking a leadership role on your unit, versus those that aren't taking a leadership role, still I think everybody's commitment and compliance to the standards can be elevated through that model.

Whether or not they want to be actively involved, I think peers holding each other accountable just raises the bar for everyone. So from that perspective, maybe they're not proactively involved, but they're involved. Everybody has a different role that they play throughout their career and experiences that they're going through in life; sometimes they can take an active role and other times they don't.

I think we have to respect where that person is at that time, but still hold each other accountable to what the standards are, what the practices are, and what the outcomes we're going after, and helping everybody be onboard with that. I think that is very possible. But for everybody to take a leadership role in that, it isn't [possible], not at the same time at least.

Davis: There's so many different areas that we can focus on. One of the principles that we use [is] when folks have energy for a particular topic, let's go there, and let's really leverage their willingness to be involved and their engagement and to the extent that we can alter the priorities on a particular agenda, and get engagement we do that.

Because I think we need the nursing staff to focus on things that are important to them. And I think that helps you grow your early adopters, and when people start to see improvement they're much more apt to get involved.